MIPS Basics



The 2020 MIPS performance period is from January 1, 2020 to December 31, 2020. Following the performance period, if you submit 2020 data for MIPS by March 31, 2021, you’ll receive a positive, negative, or neutral payment adjustment in the 2022 payment year, which will be based on your MIPS Final Score.



2020 Quality Requirements

This percentage can change due to Special Statuses, Hardship Exception Applications, reweighting of other performance categories, or Alternative Payment Model (APM) participation.

Quality – 45% - 90 continuous days

Participants must collect measure data for the 12-month performance period (January 1 - December 31, 2020). The amount of data that must be submitted depends on the collection (measure) type.

There are 6 collection types for quality measures:

General reporting requirements (for those not reporting through the CMS Web Interface):

  • You will typically need to submit collected data for at least 6 measures (including 1 outcome measure or high-priority measure in the absence of an applicable outcome measure), or a complete specialty measure set.
  • You will need to report performance data for 70% of the patients who qualify for each measure (data completeness).
  • You can submit measures from different collection types (except CMS Web Interface measures) to fulfill the requirement to report 6 measures.

How Should I Submit Data?

There are 4 submission types you can use for quality measures, depending on what submitter type you are. The submission types are:

  • Medicare Part B claims
  • Sign in and upload
  • CMS Web Interface
  • Direct submission via API

Bonus Points

You can earn quality bonus points in the following ways:

  • Submit 2 or more outcome or high priority quality measures.
    • This bonus is not available for the first, required outcome or high priority quality measure.
    • This bonus is not available for measures required by the CMS Web Interface, but is available to groups that report the CAHPS for MIPS survey in addition to the CMS Web Interface measures.
  • Submit using End-to-End Electronic Reporting, with quality data directly reported from a certified EHR technology (CEHRT).

Six bonus points are added to the Quality performance category score for clinicians in small practices who submit at least 1 measure, either individually or as a practice or virtual group. This bonus is not added to clinicians or groups who are scored under facility-based scoring.

You can also earn up to 10 additional percentage points based on your improvement in the Quality performance category from the previous year.

For additional information click here:

2020 PI Requirements

This percentage can change due to Special Statuses, Hardship Exception Applications, reweighting of other performance categories, or Alternative Payment Model (APM) participation.

Requirements

For Performance Year 2020, 2015 Edition CEHRT is required for participation in this performance category.

You must submit collected data for certain measures from each of the 4 objectives measures (unless an exclusion is claimed) for the same 90 continuous days (or more) during 2020.

In addition to submitting measures, you must provide your EHR’s CMS Identification code from the Certified Health IT Product List (CHPL) and submit a “yes” to:

  • The Prevention of Information Blocking Attestation,
  • The ONC Direct Review Attestation, and;
  • The security risk analysis measure.

Hardship Exceptions

You may submit a Promoting Interoperability Hardship Exception Application, citing one of the following reasons for review and approval:

  • MIPS eligible clinician in a small practice
  • MIPS eligible clinician using decertified EHR technology
  • Insufficient Internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of CEHRT

If your hardship exception is approved, the Promoting Interoperability performance category will receive zero weight when calculating your final score and the 25% will be redistributed to another performance category (or categories) unless you submit data for this performance category.

Some clinicians will be automatically reweighted based on special status (for example, hospital-based clinicians) or their clinician type (for example, a physical therapist, occupational therapist, or clinical psychologist). These clinicians will not need to submit a Promoting Interoperability Hardship Exception Application.

If you're reporting as a group or virtual group, all MIPS eligible clinicians in the group or virtual group must qualify for reweighting for the group to be reweighted, unless the group or virtual group has a special status that qualifies them for automatic reweighting.

How Should I Submit Data?

There are 3 submission types you can use for your Promoting Interoperability performance category data, depending on which submitter type you are. The submission types are:

  • Sign in and attest Bonus Points
  • Sign in and upload
  • Direct submission via API

UPDATED Bonus Points

You can earn 5 bonus points for submitting a yes for the optional measure, Query of Prescription Drug Monitoring (PDMP).

For additional information click here:

2020 Improvement Activities Requirements

This percentage can change due to Hardship Exception Applications or Alternative Payment Model (APM) participation

What Improvement Activities Data Should I Submit?

To earn full credit in this performance category, you must generally submit one of the following combinations of activities:

  • 2 high-weighted activities
  • 1 high-weighted activity and 2 medium-weighted activities, or
  • 4 medium-weighted activities

Improvement activities have a continuous 90-day performance period (during CY 2020) unless otherwise stated in the activity description.

UPDATED For group reporting, a group or virtual group can attest to an activity when at least 50% of the clinicians in the group or virtual group perform the same activity during any continuous 90-day period (or as specified in the activity description) in the same performance year.

How Should I Submit Data?

There are 3 submission types you can use for Improvement Activities, depending on which submitter type you are. The submission types are:

  • Sign in and attest
  • Sign in and upload
  • Direct submission via API

For additional information click here:

2020 Cost Requirements

This percentage can change if you do not meet the minimum case volume for at least one cost measure. If there are not enough attributed patients for any of the 20 measures to be scored, the Cost performance category will receive zero weight when calculating your final score and the 15% will be distributed to another performance category (or categories).

For Performance Year 2020, we use cost measures that assess the total cost of care during the year, or during a hospital stay, and/or during 18 episodes of care for Medicare patients. There are 20 cost measures available for Performance Year 2020.

MIPS Alternative Payment Model (APM) participants are not scored on cost under the APM scoring standard.

What Cost Data Should I Submit?

We use Medicare Part A and B claims data to calculate cost measure performance which means clinicians and groups do not have to submit any data for this performance category.

For additional information click here: